Anifrolumab

In patients who are being treated with other medicines that are CYP substrates with a narrow therapeutic index, where the dose is individually adjusted (e.g., warfarin), therapeutic monitoring is recommended.

There is no experience in patients with severe renal impairment or end-stage renal disease.

The impact of treatment with anifrolumab on the potential development of malignancies is not known. Studies in patients with a history of malignancy have not been conducted; however, patients with squamous or basal cell skin cancers and uterine cervical cancer that had been fully excised or adequately treated were eligible for enrolment in the SLE clinical trials.

In the placebo-controlled clinical trials, at any dose, malignant neoplasm (including non-melanoma skin cancers) was reported for 1.2% patients receiving anifrolumab, compared to 0.6% patients receiving placebo (EAIR: 1.2 and 0.7 per 100 patient years, respectively). Malignancies excluding non-melanoma skin cancers were observed in 0.7% and 0.6% of patients receiving anifrolumab and placebo, respectively. In patients receiving anifrolumab, breast and squamous cell carcinoma were the malignancies observed in more than one patient.

Individual benefit-risk should be considered in patients with known risk factors for the development or reoccurrence of malignancy. Caution should be exercised when considering continuing therapy for patients who develop malignancy.

Due to the mechanism of action, anifrolumab should be used with caution in patients with a chronic infection, a history of recurrent infections, or known risk factors for infection. Treatment with anifrolumab should not be initiated in patients with any clinically significant active infection until the infection resolves or is adequately treated. Patients should be instructed to seek medical advice if signs or symptoms of clinically significant infection occur. If a patient develops an infection, or is not responding to standard therapy, they should be closely monitored and careful consideration given to interrupting anifrolumab therapy until the infection resolves.

Anifrolumab has not been studied in combination with other biologic therapies, including B-cell targeted therapies. Therefore, treatment with anifrolumab is not recommended in combination with biologic therapies.

There are limited data (less than 300 pregnancy outcomes) from the use of anifrolumab in pregnant women.

Animal studies are inconclusive with respect to reproductive toxicity.

Anifrolumab is not recommended during pregnancy and in women of childbearing potential not using contraception, unless the possible benefit justifies the potential risk.

It is not known whether anifrolumab is excreted in human milk. Anifrolumab was detected in the milk of female cynomolgus monkeys.

A risk to the suckling child cannot be excluded.

A decision must be made whether to discontinue breast-feeding or to discontinue from anifrolumab therapy, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.

Fertility

There are no fertility data in humans.

Animal studies show no adverse effects of anifrolumab on indirect measures of fertility.

Anifrolumab has no or negligible influence on the ability to drive and use machines.

Summary of the safety profile

The most commonly reported adverse reactions during anifrolumab treatment were upper respiratory tract infection (34%), bronchitis (11%), infusion-related reaction (9.4%) and herpes zoster (6.1%). The most common serious adverse reaction was herpes zoster (0.4%).

Tabulated list of adverse reactions

Adverse reactions reported from controlled clinical trials are classified by MedDRA System Organ Class (SOC), see table. Within each SOC, preferred terms are arranged by decreasing frequency and then by decreasing seriousness. Frequencies of occurrence of adverse reactions are defined as: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1 000 to <1/100); rare (≥1/10 000 to <1/1 000); very rare (<1/10 000) and not known (cannot be estimated from available data).

Adverse reactions:

^* Grouped terms: Upper respiratory tract infection (including Upper respiratory tract infection, Nasopharyngitis, Pharyngitis); Bronchitis (including Bronchitis, Bronchitis viral, Tracheobronchitis); Respiratory tract infection (including Respiratory tract infection, Respiratory tract infection viral, Respiratory tract infection bacterial).
^§ see ‘Description of selected adverse reactions’ below.

Description of selected adverse reactions

Hypersensitivity and infusion-related reactions

The incidence of hypersensitivity reactions was 2.8% in the anifrolumab group and 0.6% in the placebo group. All hypersensitivity reactions were reported within the first 6 infusions. Hypersensitivity reactions were predominantly mild to moderate in intensity and did not lead to discontinuation of anifrolumab therapy. One serious adverse reaction of hypersensitivity was reported during the patient’s first infusion; the patient continued to receive anifrolumab with premedication given for subsequent infusions.

In the SLE development program, anaphylactic reaction was reported for 0.1% (1/837) of patients; the event occurred following the administration of 150 mg anifrolumab, the patient was treated and recovered.

The incidence of infusion-related reactions was 9.4% in the anifrolumab group and 7.1% in the placebo group. Infusion-related reactions were mild or moderate in intensity (the most common symptoms were headache, nausea, vomiting, fatigue, and dizziness); none were serious, and none led to discontinuation of anifrolumab. Infusion-related reactions were most commonly reported at the start of treatment, on the first and second infusions, with fewer reports on subsequent infusions.

Respiratory infections

Reporting rates for anifrolumab compared to placebo were; upper respiratory tract infection (34.4% vs 23.2%), bronchitis (10.7% vs 5.2%) and respiratory tract infection (3.3% vs 1.5%). Infections were predominantly non-serious, mild or moderate in intensity and resolved without discontinuation of anifrolumab therapy.

Herpes zoster

The incidence of herpes zoster infections was 6.1% in the anifrolumab group and 1.3% in the placebo group. In the 52-week clinical trials the mean time to onset was 139 days (range 2–351 days).

Herpes zoster infections were predominantly of localised cutaneous presentation, mild or moderate in intensity and resolved without discontinuation of anifrolumab therapy. Cases with multidermatomal involvement and cases of disseminated disease (including central nervous system involvement) have been reported.

Immunogenicity

In the Phase III trials, treatment-emergent anti-drug antibodies were detected in 6 out of 352 (1.7%) patients treated with anifrolumab at the recommended dosing regimen during the 60-week study period. Due to methodological limitations, the clinical relevance of this finding is not known.